MAPD
2027 plan HMO
SCAN Costco Medicare Advantage (HMO)
Plan information effective January 1, 2027.
Plan costs & ratings
Monthly premium$0.00
Medical premium$0.00
Drug premium$0.00
Annual premium$0.00
Medical deductible$0
Drug deductible$450
Max OOP in network$2,900
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in 4 California countiesPlacer County, CA, Sacramento County, CA, San Joaquin County, CA, Yolo County, CA
Available Cities
This plan is available in 33+ cities in California.
Auburn
Placer County
Carnelian Bay
Placer County
Emigrant Gap
Placer County
Foresthill
Placer County
Lincoln
Placer County
Newcastle
Placer County
Rocklin
Placer County
Roseville
Placer County
Tahoe City
Placer County
Carmichael
Sacramento County
Citrus Heights
Sacramento County
El Dorado Hills
Sacramento County
Elk Grove
Sacramento County
Fair Oaks
Sacramento County
Galt
Sacramento County
Herald
Sacramento County
North Highlands
Sacramento County
Orangevale
Sacramento County
Rancho Cordova
Sacramento County
Sacramento
Sacramento County
Escalon
San Joaquin County
French Camp
San Joaquin County
Lathrop
San Joaquin County
Lodi
San Joaquin County
Manteca
San Joaquin County
Ripon
San Joaquin County
Stockton
San Joaquin County
Tracy
San Joaquin County
Brooks
Yolo County
Bryte
Yolo County
Davis
Yolo County
Winters
Yolo County
Woodland
Yolo County
Benefits
Primary care
In Network
In-Network: $0 copay per visit
Inpatient hospital
In Network
In-Network: $99 copay per day for days 1-5, $0 copay per day for days 6-90.
Skilled nursing
In Network
In-Network: $0 copay per day for days 1-20, $125 copay per day for days 21-100.
Emergency care
In Network
In-Network: $120 copay per visit
Urgently needed care
In Network
In-Network: $0 copay for Medicare-covered urgently-needed-care visits.
Ambulance
In Network
In-Network: $150 copay per trip
Plan Overview
CarrierSCAN Health Plan
OrganizationSCAN HEALTH PLAN
Plan typeMAPD
PlanHMO
Drug coverageIncluded
Enrollment hours8 am to 8 pm
Provider searchOpen provider directory
Carrier websiteOpen website
Plan identifiers
Plan IDH5425-138-000
Plan number138
ContractH5425
Segment0
DRX ID1M5SR81LRN
Carrier ID15
Formulary ID27384
Formulary versionV11 Last Updated 09-01-2026
Carrier contact
Carrier phone8336089576
Enrollment phone8336089576
Enrollment TTY711
Carrier hours8 am to 8 pm
Network & documents
Preferred pharmacy networkYes
Preferred retail pharmacyYes
Preferred mail pharmacyYes
Mail drug benefitsYes
Provider searchYes